Citation Nr: 21062278 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 17-55 483 DATE: October 6, 2021 REMANDED Entitlement to service connection for a respiratory condition, claimed as lung nodules, is remanded. Entitlement to service connection for asthma is remanded. Entitlement to service connection for a larynx condition, claimed as hoarseness, is remanded. Entitlement to service connection for thyroid nodules is remanded. Entitlement to service connection for hepatic and splenic calcifications is remanded. Entitlement to service connection for anxiety secondary to respiratory conditions is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1965 to February 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In the Veteran's October 2017 VA Form 9 substantive appeal, he requested a Board hearing by live videoconference. In September 2021, VA received notice from the Veteran's representative that the Veteran desired to withdraw his hearing request. The Veteran has related that he was exposed to asbestos during service, and he contends that he has a current lung condition, asthma, thyroid condition, liver or spleen condition, and larynx condition related to those exposures. He also contends he has an anxiety condition secondary to his respiratory conditions. After review of the record, the Board finds that remand is required for all claims in order to provide medical examinations and etiology opinions. Regarding a lung condition and asthma, a respiratory C&P examination was provided in July 2014. The examiner noted the Veteran's diagnoses of COPD and asthma and opined that they were less likely than not related to the Veteran's in-service asbestos exposure, which the examiner characterized as "brief and only [over the course of] 2 months." It was noted that the Veteran does not have a diagnosis of any other asbestos-related pleural disease. Of record is an August 2017 treatment note from the Veteran's VA pulmonologist, Dr. A.D., noting an impression of COPD and lung nodules and opining that "[i]t is as likely as not that his lung conditions are related to asbestos exposure," with no further reasoning provided. Along with this opinion the Veteran submitted articles on the topic of asbestos diseases, including an article "Occupational Airborne Exposure and the Incidence of Respiratory Symptoms and Asthma" that concluded that "occupational airborne exposure [to asbestos] . . . increases the risk for developing respiratory symptoms and asthma." In light of the negative C&P opinion, followed by Dr. A.D.'s positive opinion, which lacked any reasoning, and the medical study submitted by the Veteran that is supportive of a link between respiratory symptoms and asbestos exposure, the Board finds that remand is appropriate in order to obtain a further opinion regarding the etiology of the Veteran's lung condition and asthma. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Regarding a condition of the larynx, the Veteran has contended that he experiences hoarseness in his throat, and treatment records show the Veteran has sought treatment for the hoarseness as well as for a sore throat. A February 1969 service treatment record recorded that the Veteran had occasional sore throat. Given this evidence, a VA examination specifically considering the Veteran's larynx and throat should be provided. McLendon v. Nicholson, 20 Vet. App. 79, 83, 86 (2006) (applying 38 U.S.C. § 5103A(d)); see also 38 C.F.R. § 3.159(c)(4). Regarding a thyroid condition and a liver or spleen condition, the evidence reflects that the Veteran has three nodules on his thyroid and hepatic and splenic calcifications. He has not yet been provided an examination and opinion regarding any potential to connection to asbestos exposure, or regarding his alternative contentions of exposure to jet fuel or an oily tar substance containing PCBs. The claims therefore will be remanded in order to provide examinations. Id. Finally, regarding an anxiety disorder, the Veteran and his wife have submitted statements detailing that when he experiences respiratory symptoms, he has a "doom & gloom" feeling with anxiety and panic. An examination has not yet been provided regarding this claimed condition, so it will be remanded for consideration of whether the Veteran has a current acquired psychiatric disorder linked to any of his other conditions. Id. Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for an examination regarding the nature and etiology of respiratory conditions, to include diagnosed COPD, lung nodules, and asthma, that may be manifesting in the Veteran's reported dyspnea, wheezing, and/or coughing. For any condition diagnosed, the examiner must opine on the following: (a) Is the condition at least as likely as not related to the Veteran's exposure to asbestos during service, in which he was present when slabs of asbestos were cut with a table saw, spreading dust in the air, and in which he worked on a project installing asbestos pads overhead, getting flakes of asbestos on his hands, hair, clothing, and in his mouth? (b) Is the condition at least as likely as not related to occasional exposure to fumes and contact with jet fuel (e.g., JP-4)? (c) Is the condition at least as likely as not related to any exposure to PCBs (described by the Veteran as present in a black oily tar substance that got on his fingers)? In rendering this opinion, the examiner should consider and discuss (i) an August 2017 statement from the Veteran's VA pulmonologist, Dr. A.D., that the Veteran's COPD and lung nodules are at least as likely as not related to his asbestos exposure; as well as (ii) a study "Occupational Airborne Exposure and the Incidence of Respiratory Symptoms and Asthma" (received into the virtual record 8/16/2017) that concluded that "exposure [to asbestos] increases the risk for developing respiratory symptoms and asthma." 2. Schedule the Veteran for an examination regarding the nature and etiology of a larynx condition manifesting in hoarseness and/or a sore throat. For any condition diagnosed, the examiner must opine on the following: (a) Is the condition at least as likely as not related to the Veteran's exposure to asbestos during service, in which he was present when slabs of asbestos were cut with a table saw, spreading dust in the air, and in which he worked on a project installing asbestos pads overhead, getting flakes of asbestos on his hands, hair, clothing, and in his mouth? (b) Is the condition at least as likely as not related to occasional exposure to fumes and contact with jet fuel (e.g., JP-4)? (c) Is the condition at least as likely as not related to any exposure to PCBs (described by the Veteran as present in a black oily tar substance that got on his fingers)? The examiner should consider and discuss the in-service February 1969 service treatment record at the time of the Veteran's separation he had had an occasional sore throat during service. 3. Schedule the Veteran for an examination regarding the nature and etiology of the Veteran's thyroid nodules. The examiner must opine on the following: (a) Is the condition at least as likely as not related to the Veteran's exposure to asbestos during service, in which he was present when slabs of asbestos were cut with a table saw, spreading dust in the air, and in which he worked on a project installing asbestos pads overhead, getting flakes of asbestos on his hands, hair, clothing, and in his mouth? (b) Is the condition at least as likely as not related to occasional exposure to fumes and contact with jet fuel (e.g., JP-4)? (c) Is the condition at least as likely as not related to any exposure to PCBs (described by the Veteran as present in a black oily tar substance that got on his fingers)? 4. Schedule the Veteran for an examination regarding the nature and etiology of the Veteran's hepatic and splenic calcifications. The examiner must opine on the following: (a) Is the condition at least as likely as not related to the Veteran's exposure to asbestos during service, in which he was present when slabs of asbestos were cut with a table saw, spreading dust in the air, and in which he worked on a project installing asbestos pads overhead, getting flakes of asbestos on his hands, hair, clothing, and in his mouth? (b) Is the condition at least as likely as not related to occasional exposure to fumes and contact with jet fuel (e.g., JP-4)? (c) Is the condition at least as likely as not related to any exposure to PCBs (described by the Veteran as present in a black oily tar substance that got on his fingers)? (Continued on the next page) 5. Schedule the Veteran for an examination regarding the nature and etiology of any acquired psychiatric disorder manifesting in attacks of anxiety (described as "doom & gloom") when he experiences respiratory symptoms such as shortness of breath. The examiner is asked to opine whether any diagnosed psychiatric condition at least as likely as not is (i) proximately due to or (ii) aggravated (worsened beyond the natural progression) by any of the Veteran's other conditions (regardless of whether they are yet service-connected), to include COPD, lung nodules, and/or asthma. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.